SRS115 - Ethnic disparities in hip and knee arthroplasty outcomes: a nationwide cohort study

Abstract Background Emerging evidence from US-based studies suggests ethnic minority patients may experience poorer outcomes following hip and knee arthroplasty. However, evidence within the NHS is limited. This nationwide cohort study examined ethnic disparities in (1) all-cause mortality and (2) postoperative outcomes following total hip arthroplasty (THA), total knee arthroplasty (TKA), hip resurfacing (HRA), and unicompartmental knee arthroplasty (UKA) in England Methods A retrospective cohort study was conducted using linked national datasets: HES, CPRD and ONS, between 1998–2021. Caucasian and ethnic minority patients were matched in a 5:1 ratio on the basis of propensity scores. The primary outcome was all-cause mortality, as Firth-corrected Cox proportional hazard ratios (HRs). Secondary outcomes included postoperative complications within one year, as Odds Ratios (ORs). Statistical significance was set at P < 0.05. Results Among 958 443 procedures, 182 353 Caucasian patients were matched to 47 695 ethnic minority patients. Ethnic minority status was associated with lower all-cause mortality (HR: 0.78, 95% c.i.: 0.76–0.81, P < 0.01), but higher odds of complications: critical care admission (OR: 1.74, 95% c.i.: 1.67–1.81, P < 0.01), myocardial infarction (OR: 1.36, 95% c.i.: 1.17–1.57, P < 0.01), venous thromboemolism (OR: 1.39, 95% c.i.: 1.31–1.47, P < 0.01), readmission (OR: 1.46, 95% c.i.: 1.41–1.50, P < 0.01), and longer length of stay (β = 0.67 days, 95% c.i.: 0.59–0.75, P < 0.01). Conclusions This study highlights significant ethnic disparities in postoperative outcomes. These findings underscore the importance of tailored, risk-stratified care strategies that account for differential perioperative risks and long-term trajectories across ethnic groups.